J Korean Med Sci.  2019 Feb;34(7):e58. 10.3346/jkms.2019.34.e58.

Aggressive Contact Investigation of In-Hospital Exposure to Active Pulmonary Tuberculosis

• Park SY
• Lee EJ
• Kim YK
• Lee SY
• Kim GE
• Jeong YS
• Kim JH
• Kim TH

• KMID: 2438309
• DOI: http://doi.org/10.3346/jkms.2019.34.e58

Abstract

BACKGROUND
In-hospital detection of newly diagnosed active pulmonary tuberculosis (TB) is important for prevention of potential outbreaks. Here, we report our experience of the aggressive contact investigation strategy in a university hospital in the Republic of Korea after healthcare workers (HCWs), patients, and visitors experience an in-hospital exposure to active pulmonary TB.
METHODS
A contact investigation after the unexpected detection of newly diagnosed active pulmonary TB (index patients) was performed in a university hospital from August 2016 to April 2017. Initial and 3-month-post-exposure chest radiographs were advised for all patients, visitors, and HCWs in close contact with the index patients. An additional tuberculous skin test or interferon gamma releasing assay was performed at the time of exposure and 3 months post-exposure in HCWs in close contact with the index patients.
RESULTS
Twenty-four index patients were unexpectedly diagnosed with active pulmonary TB after admission to the hospital with unassociated diseases. The median time from admission to TB diagnosis was 5 days (range, 1-22 days). In total, 1,057 people were investigated because of contact with the index patients, 528 of which had close contact (206 events in 157 HCWs, 322 patients or visitors). Three months post exposure, 9 (9.2%) among 98 TB-naïve close contact HCWs developed latent tuberculosis infections (LTBIs). Among the 65 close contact patients or visitors, there was no radiological or clinical evidence of active pulmonary TB.
CONCLUSION
An aggressive contact investigation after an unexpected in-hospital diagnosis of active pulmonary TB revealed a high incidence of LTBI among TB-naïve HCWs who had contact with the index patients.

Keyword

Mycobacterium; Latent Tuberculosis; Healthcare Personnel; Infection Control

MeSH Terms

Delivery of Health Care
Diagnosis
Disease Outbreaks
Humans
Incidence
Infection Control
Interferons
Latent Tuberculosis
Mycobacterium
Radiography, Thoracic
Republic of Korea
Skin Tests
Tuberculosis, Pulmonary*
Interferons